Tendinitis

What is it?

Arthritis is a complex family of musculoskeletal disorders consisting of more than 100 different diseases or conditions that destroy joints, bones, muscles, cartilage and other connective tissues, hampering or halting physical movement. A tendon is a cord of tough tissue that connects muscle to bone. The tendon is surrounded by a sheath that protects and lubricates the tendon. This sheath is lined by a layer of cells called the synovium. Occasionally, the tendon will become inflamed (called tendinitis) or the tendon sheath will become inflamed (called tenosynovitis). These conditions together are known as tendinitis and result in pain, stiffness and sometimes swelling.

Tendinitis usually is caused by a specific injury or by repetitive overuse, especially when using poor body position. Tendinitis can occur in young athletic people in response to sports injuries and overuse. However, tendons become less flexible with aging and tendinitis is common in middle aged and older adults.

In general, tendinitis can occur suddenly, may last for days, weeks or longer, and then go away. It can, however, occur again in the same place. When properly treated, it general doesn’t result in permanent damage or disability.

What are the effects?

Tendons all over the body can become inflamed, including shoulders, elbows, wrists, fingers, hips, back, knees, ankles and feet. The symptoms usually include pain, stiffness and swelling.

How is it diagnosed?

Diagnosing tendinitis is based primarily on a physical exam and a medical history. Your doctor will look for swelling and tenderness in the area that is bothering you. He or she will rule out infection if there is no heat and redness associated with the swelling and tenderness. He or she will ask you about the pain and about what types of activities you are involved in. That is usually enough for the doctor to diagnose tendinitis. If the diagnosis is in question or if the doctor suspects that you may have an underlying inflammatory disease, he or she may run some routine laboratory tests and X-rays.

What are the treatment options?

Tendinitis is common in people who are otherwise healthy. It may go away on its own over time. In most cases, a primary-care physician can treat tendinitis. Some people may need to be referred to a rheumatologist, an orthopaedic surgeon or a physical therapist for treatment.

Tendinitis is treated with a conservative approach. Your doctor may recommend a combination of rest, activity modification, heat and cold, medications, and physical therapy.

Rest: The affected tendon should be rested so it can heal. You may have to stop performing the offending activity for a short period of time.

Activity modification: The activity that caused the injury should be modified in such a way as to relieve the stress on the tendon. For example, if running gave you Achilles tendinitis, you may need to reduce your mileage, wear different shoes and then increase your mileage slowly.

Splints: Sometimes splints are used to keep the affected joint in alignment during activities so stress is taken off the tendon (such splints and wraps are available for tennis elbow). Splints may also be used during the initial resting period to allow the tendon to heal.

Cold and heat: Cold packs, slush baths, and ice rubs can reduce pain and swelling when the tendon is newly injured or is really bothering you. Hot packs, heating pads, or warm baths can feel good for the long-term ache that you may feel from an overuse injury.

Medication:

Nonsteroidal anti-inflammatory drugs (NSAIDs) can be taken to relieve the pain and swelling of tendinitis. Other analgesics can be added for pain relief.

Steroids can be injected into the tendon sheath for very direct pain and inflammation relief. Certain tendons should not be injected with steroids because it puts the tendon as risk of rupture (the Achilles for example).

Physical therapy: A physical therapist can teach techniques to stretch the affected tendon, thereby reducing the likelihood of reinjury. He or she can also assess your body mechanics and teach you better ways to perform the activities that give you trouble. Shoe inserts (orthotics) may be needed to adjust your running form, relieving pressure on your knee and Achilles tendons.

Surgery: Rarely surgery may be needed to relieve the symptoms of tendinitis. Surgery would also be necessary if the affected tendon tore or ruptured.

What resources are available?

The Arthritis Foundation leads the way in helping people with arthritis live better today and create better tomorrows through new treatments, better access and, ultimately, cures. We do this by:

Funding life-changing research that has restored mobility in patients for more than six decades

Fighting for health care policies that improve the lives of the millions of Americans with arthritis

Partnering with families to provide empowering programs and information

If you are diagnosed with tendinitis, some Arthritis Foundation resources that may help you better manage and live with your disease are: